Talk:Heated tobacco product/Archive 5

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Summoned by bot, three times, unable to discern the question(s)

My prior experience with this topic disinclined me to participate but I came by to see what all the RfCs were about. If you all need fresh eyes and I think it's likely, you need to make it much more clear what is actually going on. Wandering off to make better use of my time. Elinruby (talk) 19:07, 21 January 2019 (UTC)

That's not an electric smoking system.

THIS is an electric smoking system! --Guy Macon (talk) 20:12, 24 January 2019 (UTC)

See diffs here and here for when it was moved. QuackGuru (talk) 23:30, 24 January 2019 (UTC)

Ah. "Heat-not-burn tobacco product" was a dreadful page name, and pretty much anything would have been an improvement, but I seriously expected this to be about smoking meat with wood chips heated by electricity. Before I even bother trying to come up with a better name, could someone please explain in plain language in what way this is different from an Electronic cigarette? Are there any sources that distinguish between the two? --Guy Macon (talk) 23:58, 24 January 2019 (UTC)

See this updated version and read the first paragraph. I recommend moving it to "Heated tobacco product". QuackGuru (talk) 00:49, 25 January 2019 (UTC)

So basically an electronic cigarette heats and vaporizes a liquid with an electric heater and a heated tobacco product heats actual tobacco with an electric heater? Can the heated tobacco product be used to heat other kinds of leaves, such as marijuana? --Guy Macon (talk) 04:48, 25 January 2019 (UTC)

This suggests you can use some forms of dried tobacco in a "dried herb" vaporizer (i.e. the ones marketed for cannabis) but it may not be a manufacturer-sanctioned function. All of the vaporizers I've seen marketed to cannabis users here are dry herb vaporizers, and some have adapters for liquid concentrates, whether they use special cartridges or just have a refillable reservoir. I always thought vapes made for tobacco used liquid concentrate cartridges exclusively, but I have no experience with them at all.

Question related to this and the move request: is this article meant to be about the device used for vaping or the product that goes in it? Or both? Ivanvector (^Talk/_Edits) 18:20, 25 January 2019 (UTC)

The tobacco that is heated is the scope of the article. There could be heated tobacco products that use herbs or even use liquid. QuackGuru (talk) 20:55, 25 January 2019 (UTC)

Yes, you can use these for cannabis; as I recall the article did mention this at some point. Agreed that the title is poor, but "heated tobacco" is worse. Using this product is not vaping (though the large amount of moisture incorporated in the cigarettes mixes the smoke with large amounts of wet steam, which could give the impression that it is water vapour). The cigarettes that go into the devices seem to be proprietary and device-specific, but obviously the loose-leaf-fill devices can take anything. So the article covers both the electric charring devices and their product-specific refills. HLHJ (talk) 19:30, 27 January 2019 (UTC)

The current article does not mention cannabis but the draft does. See Draft:Electric smoking system#Firefly 2 for content about cannabis. A few of these products can use cannibals. There are hybrid products that also use liquid. See Draft:Electric smoking system for content about using liquid. For example, "They can overlap with e-cigarettes such as a combination of an e-cigarette and a heat-not-burn tobacco product, for the use of tobacco or e-liquid.[17]" It is vaping when a product uses liquid. QuackGuru (talk) 22:23, 27 January 2019 (UTC)

Proposal to remove the dmy dates and British English

Should we remove the dmy dates and British English notes at the top of the page (the hatnote for e-cigs will remain)? QuackGuru (talk) 21:26, 24 January 2019 (UTC)

• Support, as proposer. I propose to keep the hatnote for the e-cigs but remove the dmy dates and British English. The article does not use British English. The dmy dates is not the way the dates are consistently written throughout this article. For example, June 26, 2014 is the standard for this article rather than 26 June 2014 for the dates. QuackGuru (talk) 21:26, 24 January 2019 (UTC)
• Oppose per WP:RETAIN. Dekimasuよ! 05:44, 26 January 2019 (UTC)
  • Per WP:RETAIN we should stick to consensus for the dates. See the date "June 26, 2014", for example.[1][2] The citations are formatted differently than the dates in the body of the article. QuackGuru (talk) 11:00, 28 January 2019 (UTC)
• Per the discussion below, this is a moot issue. Seppi333 (Insert 2¢) 16:13, 29 January 2019 (UTC)
  • What I was originally asking was not accurate and I was not explaining it properly. @Ivanvector: this RfC can be closed. See discussion below. QuackGuru (talk) 17:23, 29 January 2019 (UTC)

Discussion

"When an English variety's consistent usage has been established in an article, maintain it in the absence of consensus to the contrary." See MOS:RETAIN.

"If an article has evolved using predominantly one date format, this format should be used throughout the article, unless there are reasons for changing it based on strong national ties to the topic or consensus on the article's talk page." See MOS:DATERET. QuackGuru (talk) 08:10, 26 January 2019 (UTC)

This issue didn't require an RFC. If, at the time it was tagged, the article used primarily British English, then it should stay that way. However, per my edit summary in this diff, I've removed that tag because the article contained primarily American English at that time. Simply adding a British English tag to the article doesn't necessitate changes to all the spelling; it's supposed to inform future editors that the current version uses that form of English and future edits should as well. If that's not the case, such as with this article in this diff, then the tag needs to be removed. Hence, I've removed the tag. As for the DMY dates, I'll check what the article currently uses more often (DMY vs MDY) and set all the dates to the majority format. Seppi333 (Insert 2¢) 03:20, 28 January 2019 (UTC)

DMY was used far more frequently than MDY, so MOS:DATERET indicates that's what should be used unless there's consensus to change it. Seppi333 (Insert 2¢) 03:24, 28 January 2019 (UTC)

The citations use dates such as 24 August 2016 but the text in the body of the article where editors read the article uses dates such as June 26, 2014. I was not clear in my proposal. My mistake.

Please check the article history. See "The introduction of iQOS (I-Quit-Ordinary-Smoking[8]) was announced on June 26, 2014.[34]"[3]

Per MOS:DATERET and per WP:RETAIN we should retain the dates such as June 26, 2014. See back in May 2017 for the date in the body of the article. See "Heatsticks is marketed under the "Marlboro brand" by Philip Morris. Introduction of the product was announced June 26, 2014 in Richmond, Virginia."[4] QuackGuru (talk)

A sock puppet originally added the dmy dates and British English tags. QuackGuru (talk) 11:12, 28 January 2019 (UTC)

In that case, I will set the reference dates to DMY, but the body dates to MDY. Seppi333 (Insert 2¢) 16:04, 29 January 2019 (UTC)

Nevermind, the datenum script doesn't seem to allow me to do that despite including it as an option. I assume the references need to be included in the article like this in order for the script to recognize the different between a body date and a reference date. Seppi333 (Insert 2¢) 16:10, 29 January 2019 (UTC)

FWIW, I don't think it's a big deal. Amphetamine and Beta-Hydroxy beta-methylbutyric acid are FAs that, like this article, use both American English and DMY date formats. Seppi333 (Insert 2¢) 16:11, 29 January 2019 (UTC)

See "The introduction of IQOS was announced on 26 June 2014.[60]"

Change to "The introduction of IQOS was announced on June 26, 2014.[60]" per long standing consensus.

@Seppi333: if the date for the body of the article is changed to June 26, 2014 then this issue would be moot. QuackGuru (talk) 16:32, 29 January 2019 (UTC)

If you want to manually change the body dates to MDY, be my guest. I support that if you feel it necessary, however, keep in mind the WP:MOSNUMscript will overwrite all of your changes whenever it's used in the article to standardize reference dates. Seppi333 (Insert 2¢) 16:35, 29 January 2019 (UTC)

I think the issues have been resolved. I made the change. This RfC can be closed now. QuackGuru (talk) 17:19, 29 January 2019 (UTC)

See WP:RFCCLOSE, QuackGuru. HLHJ (talk) 02:47, 30 January 2019 (UTC)

QuackGuru's edits from Jan 9th

Hello, QuackGuru. The January 9th version of the article was quite different from the current one, which you've rewritten extensively over the past few days. You seem, in fact, to have previously re-written it in your own draft space, while continuing to discuss the content that was then in the article on this discussion page. You then seem to have replaced the existing content with the content you wrote alone. I am not without fault here; I saw your draft article by chance earlier, and should have mentioned it immediately. I was busy off-wiki and did not get around to it.

I think that this content replacement has overridden the ongoing discussions in which you were participating; you have also changed some content on which I thought we had reached consensus. For instance, we were discussing the image of charring which you removed; you started a new section, reiterated one of your earlier statements ("not related to the topic") and then removed it unilaterally. I also thought that we were still discussing the best name for the article (I think that there are issues with all the proposed names), and expected to continue that discussion (now archived). You have also described the emissions of these products as "aerosol", where I thought there was consensus that "smoke" was supported by the balance of reliable sources, and should be used throughout. I'm not trying, in this section, to discuss the merits of these arguments; this is a meta-discussion about discussion methods.

I think there is useful content in your edits. However, the lack of collaboration and discussion is a concern to me. Could you please withdraw the RfCs above and discuss the matters on this page? If we really can't agree, then an RfC may become necessary, but we should exhaust discussion first. I don't think there's yet even been a challenge on the last-mentioned issue, although I agree with you that there may well be. I would also ask that you revert to the version of the 9th of January, post a link to your alternative version of the article, and allow other editors to discuss your proposed edits, so that we can integrate them collaboratively into the article.

The older discussion archives seem not to have followed this page when it moved; can anyone advise me on how to re-link them? HLHJ (talk) 20:56, 12 January 2019 (UTC)

I explained the content you add failed verification and you did not fix it. The term smoke was not supported by sources. I was planning to start a RfC after I was done editing it. If there is anything I missed that you think is sourced please tell me what you think is sourced using one citation per sentence rather than more than one citation for each clam. I can restore content that is well sourced and neutral. Others can decide which version they think is more neutral and well sourced. If you think the current version is not useful then please show me what is the concern with the current version. I explained over and over the problems with the previous version. I did not want to revert back to an older version. I thought it would be better to just fix the ongoing problems. It was clear to me we had not reached consensus for a lot of content, including the charred pizza image. If it is reverted to an older version a lot of content may be lost. Others may disagree if it is reverted to an older and shorter version.

If you want me to revert we would go back to this version in October 2018 due to the serious problems with the December 2018 article. Please read the previous comments and archives for the continued problems. I clearly explained the charred pizza image is not related to the topic. No editor agreed with the pizza image.

Let's keep it simple. What do you think is worth including that is sourced? If we can't come to an agreement soon you can revert to a version without the disputed pizza image. Please revert if you think that improves the article. The current article is at 107,356 bytes. Do you want to lose all that useful content? I thought I let you know that all the previous versions do contain failed verification content. If you really want to revert to a previous version then that is your choice. Please revert. QuackGuru (talk) 22:34, 12 January 2019 (UTC)

Let's by all means keep it simple. We disagreed about article content; editors, including we two, had discussed it. You simultaneously wrote an alternate version of the article, which you did not mention in discussion. The discussion lapsed without consensus for your changes before the solstice. Recently, you replaced the content under discussion without regard to the discussion. Then you started RfCs about issues, one of which was being discussed, one of which I had mentioned, and two of which no-one had discussed. Now you have started an RfC offering the October 2018 and January 12 versions as options, but not the January 9th version. I think this is the wrong order. I think we should discuss, then, if we cannot agree, use dispute resolution mechanisms (agreeing to questions first, if possible), then edit the article according to the consensus. Your edits were bold, and I am asking you to self-revert them so that we can continue with the discussion. I would not object to your starting a single RfC on whether to replace the January 9th article with your proposed draft, as such an RfC might be the most efficient way to discuss it. HLHJ (talk) 22:38, 12 January 2019 (UTC)

The RfC now states Should we support the expanded version or revert back to the January 9, 2019 or the December 26, 2018 version?

January 9th version was not a finished version when I began editing. I did not start an RfC offering the October 2018. I offered the December 2018 before I began editing. For now I reverted the bold changes. QuackGuru (talk) 23:36, 12 January 2019 (UTC)

I apologize for misrepresenting your RfC, QuackGuru, it does indeed say December rather than October. I'm not sure how I came to make that mistake. On my talk page, you wrote:

Please revert back to a version such as a version before the disputed content was added, including the charred pizza image if you think that improves the article. Others may disagree if it is reverted to an older and shorter version. QuackGuru (talk) 22:30, 12 January 2019 (UTC)

Please go ahead and revert to the version you think is best. QuackGuru (talk) 22:52, 12 January 2019 (UTC)

Rather than discuss which version to revert back to I think you can revert it. I'm not sure why you have not reverted the content. If you dispute it you can revert it. It's that simple. You don't need to cont8une to discuss reverting to an older version. I insist you revert to the version you think is best. I don't understand why you have not reverted. I am not disputing you to revert. QuackGuru (talk) 23:06, 12 January 2019 (UTC)

(edit conflict, modified) Thank you for your conciliatory response, QuackGuru. I hadn't reverted it because I wanted to discuss the situation, and I prefer to ask for a self-revert rather than make major reverts of other peoples' edits. I do think that your edits contain useful content whose inclusion I would favour; I'll discuss this in the RfC below, but it will take me a while to assess all the new content. HLHJ (talk) 00:08, 13 January 2019 (UTC)

I mentioned this below, QG, but could you please also revert the image swap you did at the start of this bold change? HLHJ (talk) 03:45, 30 January 2019 (UTC)

I deleted a poor image that was added without consensus. QuackGuru (talk) 04:42, 30 January 2019 (UTC)

No, I mean where you replace a picture of IQOS that shows scale and refill packs with a very lightbox white-on-white image that shows little detail and was supplied by Phillip Morris. It looks like a textbook example for how to photograph your products for high sales volume. I don't recall how long the former had been in the article.

For disclosure, QuackGuru, I noticed you had some of the files I uploaded to commons renamed to remove the words "smoke" and "cigarette". I'm sorry I didn't see this sooner, but I disagreed with those changes. HLHJ (talk) 06:01, 30 January 2019 (UTC)

QuackGuru, you replaced the article content at 04:45, 9 January 2019. Do you have any idea why the viewership of the article was about double the modal average on the 9th, with a secondary peak on the 12th? It's still a bit above average. HLHJ (talk) 03:33, 20 January 2019 (UTC)

Hi All. my guess is it's a quirk of the news cycle, and from reporters looking for "new years resolution" type stories who all published around the same time. I saw that several reporters picked up on PMI's chatter that we want to stop selling cigarettes, and for some reason most reported it as if it's new news when it's not. Many of those were published January 9, though there were some before and some after that date, likely drawing readers to the page for more info. Even Snopes put out an article on January 11, correcting the timing of our messaging and referencing several examples of these news sources that ran the story. Cheers, Sarah at PMI (talk) 11:28, 21 January 2019 (UTC)

Right, I remember hearing the same announcement around the same time last year, (though without the only-goes-for-the-US winkle), but I didn't hear it again this year. Did you put out a press release or some such? Thanks, HLHJ (talk) 02:43, 30 January 2019 (UTC)

Nope. I'm checking our media center, and our global press releases didn't go out at a time that should have prompted the Jan 9th or 12th activity. I believe you refer to our UK affiliate's announcement last year of their new year's resolution to give up cigarettes - we've done nothing like that this year that I'm aware of. Not sure what's caught reporters' attention this time around. Best, Sarah at PMI (talk) 13:58, 30 January 2019 (UTC)

Table

Should the table below be included in the article? QuackGuru (talk) 09:52, 12 January 2019 (UTC)

• Support including table. See Talk:Heat-not-burn tobacco product/Proposed draft#Comparison to traditional cigarettes and see Talk:Heat-not-burn tobacco product#Comparison to traditional cigarettes, QuackGuru (talk) 09:52, 12 January 2019 (UTC)
• I'd support including it in the IQOS section since it seems relevant there. Also, please take note that I modified the table formatting; I assume that my changes were an improvement, but if not, feel free to revert them. Seppi333 (Insert 2¢) 06:25, 23 January 2019 (UTC)
• Oppose. This RfC was subsumed into a later one. This data is bulky, there is no evidence that this data is generally representative, and some evidence that it hinders understanding (a study found that people told that levels of some harmful substances are lower incorrectly take this to imply that the smoke is less harmful). HLHJ (talk) 19:06, 27 January 2019 (UTC)
  • Please provide evidence of your position rather than assertion there is an issue with the table.
  • See the draft page. "Exposure to mutagenic and other harmful substances is lower than with traditional cigarettes.[15] However, reduced exposure to harmful substances does not mean that health risks are equally reduced.[15] Even low exposure increases the risks for cancers, stroke, and other cardiovascular diseases compared to non-smokers.[15]" See Draft:Electric smoking system#Emissions. The draft does explain that lower levels of some harmful substances do not mean that the aerosol is less harmful. QuackGuru (talk) 19:09, 27 January 2019 (UTC)
    • Your proposed text seems to me to imply that these products are lower-risk than conventional cigarettes. I don't think this is justified by the evidence. I believe that it is the case that the reduction of concentrations of some mutagenic and otherwise harmful substances does not necessarily imply any observable reduction in risk (as was the case with ventilated cigarettes, which have lower concentrations of assorted nasties, but are not safer than regular cigarettes, though the diseases killing users change a bit). There are a large number of unstudied compounds in the smoke. Some have been seen at higher levels in smoke from these cigarettes that in smoke from standard cigarettes. Others have not been looked for yet. If any of these are mutagenic or otherwise harmful when inhaled, that could plausibly also have an effect on the risk profile. Fundamentally, we won't know if these things are safer until we have long-term human observational studies, decades after their market introduction, as it seems as if no-one did any studies on the ones that came out in the eighties (Sarah at PMI, I think I asked before, but I don't think you saw it; does PMI know of any studies observing effects on human health from decades-ago or multi-year use of these devices?).

The table is taken from a source that you are, elsewhere on this page, criticizing as inadequate to support the statement that independent researchers dispute claims that these devices are "smoke-free". It calls the emissions it is analyzing "smoke". Do you consider the source adequate for a large table of quantitative data, but inadequate for the use of the word "smoke"? Could you explain why? HLHJ (talk) 03:41, 30 January 2019 (UTC)

There are better sources available for "smoke". The draft does make it clear about the smoke in the lede and body using a 2018 review.

I stated above "See Draft:Electric smoking system#Emissions. The draft does explain that lower levels of some harmful substances do not mean that the aerosol is less harmful." This *is* justified by the evidence. QuackGuru (talk) 05:11, 30 January 2019 (UTC)

Sorry, QG, are you now arguing that the term "smoke" is supported by reliable sources (sources better than the one you wish to cite)? Or that the source you wish to cite, while supporting "smoke", should be ignored in favour of better sources which evaluate the merits of calling the emissions "smoke"? HLHJ (talk) 01:45, 31 January 2019 (UTC)

The wording was improved in the draft using a review. There is no need to repeat the word "smoke" throughout the article. QuackGuru (talk) 02:39, 31 January 2019 (UTC)

Responding specifically to HLHJ's note about clinical studies and research. PMI has conducted a six-month clinical study involving approximately 500 each of people who switched to IQOS or continued smoking cigarettes, showing a clear difference between the two groups. Info on that here (page 6) and here. This study is the closest thing I am aware of to what you're asking for - I don't know about a study like this for the older products, nor something conducted independently.

To your point about these products being or not being reduced-risk compared to cigarettes, saying "I don't think this is justified by the evidence." I'd argue that our focus should not be on what the evidence does or doesn't support, and more generally not on what specific researchers have said/concluded from their research. We should be focusing on who the topic experts are and how they summarize the available evidence of others. This comes from my noob understanding of MEDRS, so feel free to disagree and help me understand where I might be mistaken. Best, Sarah at PMI (talk) 17:06, 30 January 2019 (UTC)

OK, not supported by the balance of reliable sources. Six months is sadly not long enough to see the risk of really important harms, like cancer, strokes, and death; my guess is that a six-month study of cigarettes vs. nothing would only find throat irritation, reduced lung capacity, and other minor effects. Since many smokers quit without aids, and half of the people using IQOS seem never to have used cigarettes, IQOS vs. nothing would be a more clinically useful comparison than IQOS vs. cigarettes. HLHJ (talk) 01:45, 31 January 2019 (UTC)

Unfortunately I couldn't be more helpful with additional references. Per the sources I linked above, the endpoints in this study are associated with respiratory disease, cardiovascular disease, and cancer (if you want to know which endpoints were measured, they're listed on page 6 in the PDF). They were chosen because they're known to improve measurably around the 6 month mark in people who've quit. IQOS cannot be better than quitting (I assume we agree on that), and so the goal of this study was to see whether switching from cigarettes to IQOS can make a measurable difference compared to continued smoking over that same 6 months. I understand that this study likely won't make it to the article text, but your comment does not accurately reflect the design or the goals of the study. Best, Sarah at PMI (talk) 10:06, 31 January 2019 (UTC)

I meant to say that the design or the goals of the study do not reflect what I want to know. Parallel trials of switching to IQOS or switching to ventilated cigarettes show similar reductions in the sort of proxy endpoints generally studied in PMI's studies (biomarkers, physiological responses). However, we have long-term data on ventilated cigarettes, and we know that they aren't actually less likely to cause serious suffering and death than regular cigarettes; in other words, the proxies you cite seem to be bad proxies. We also know that very similar marketing, touting these proxy results and calling ventilated cigarettes "light", caused people to falsely believe that smoking "light" cigarettes was better for their health. We know that people chose to switch rather than quit as a result of this false belief; faced with the sheer misery of withdrawal and repeated past failures to quit, smokers were all too willing to believe there was an easier alternative. We know from internal tobacco industry documents that creating this false confidence and discouraging quitting was an intent behind the marketing. It worked (see nicotine marketing and history of nicotine marketing).

I think this fairly clearly implies that this marketing killed people. You are now working on a parallel piece of marketing.

I'm truly sorry that you are in this situation, and I think society must carry a large share of the blame. HLHJ (talk) 22:30, 2 February 2019 (UTC)

It seems this discussion is getting a bit off topic. Since I've already made my !vote below, I'll just close out by saying that the research program we have going now is miles beyond what's been done in the past. Our research is peer-reviewed and open access for anyone who is interested. Cheers! Sarah at PMI (talk) 09:43, 4 February 2019 (UTC)

• Oppose. based on MEDRS. Inserting this table lends significant weight to a single primary reference. Rather than this table, it would be better to have a sentence or two describing the views/conclusions of various experts/organizations who have reviewed the research of others on the aerosol from this product/category. Best, Sarah at PMI (talk) 17:08, 30 January 2019 (UTC)

• Opposed (invited randomly by a bot) We should be sourcing this data from review articles not a primary source. Also the lack of discipline in reserving discussion for the Comments section, rather than the !vote section, suggests POV. IMO the NOM should not be inserting comments here. I will not respond to any comments on my !vote here. Jojalozzo (talk) 00:33, 3 February 2019 (UTC)

Comments on table

• There is a new table sourced to a 2018 review added to the draft. See Draft:Electric_smoking_system#Comparison_to_mainstream_smoke_of_traditional_cigarettes. The new table makes this RfC moot. QuackGuru (talk) 18:15, 3 February 2019 (UTC)

Comparison to traditional cigarettes

Levels of 8 volatile organic substances, 16 polycyclic aromatic hydrocarbons, 3 inorganic substances, and nicotine of the IQOS product and traditional cigarettes∗ Analyzed Substance IQOS product; Amount, Mean (SD) Duplicate tests for given assay Traditional cigarettes; Amount, Mean (SD) Duplicate tests for given assay Percentage (%) of the substance in each IQOS compared to traditional cigarettes Volatile organic substances, μg per cigarette Acetaldehyde 133 (35) 5 610 1 22 Acetone 12.0 (12.9) 5 95.5 (13.5) 2 13 Acroleine 0.9 (0.6) 2 1.1 1 82 Benzaldehyde 1.2 (1.4) 5 2.4 (2.6) 2 50 Crotonaldehyde 0.7 (0.9) 5 17.4 1 4 Formaldehyde 3.2 (2.7) 5 4.3 (0.4) 2 74 Isovaleraldehyde 3.5 (3.1) 5 8.5 (10.8) 2 41 Propionaldehyde 7.8 (4.3) 5 29.6 (36.6) 2 26 Polycyclic aromatic hydrocarbons, ng per cigarette Naphthalene 1.6 (0.5) 4 1105 (269) 7 0.1 Acenaphthylene 1.9 (0.6) 4 235 (39) 7 0.8 Acenaphthene 145 (54) 4 49 (9) 7 295 Fluorene 1.5 (0.6) 4 371 (56) 7 0.4 Anthracene 0.3 (0.1) 4 130 (18) 7 0.2 Phenanthrene 2.0 (0.2) 4 292 (44) 7 0.7 Fluoranthene 7.3 (1.1) 4 123 (18) 7 6 Pyrene 6.4 (1.1) 4 89 (15) 7 7 Benz[a]anthracene 1.8 (0.4) 4 33 (4.2) 7 6 Chrysene 1.5 (0.3) 4 48 (6.2) 7 3 Benzo[b]fluoranthene 0.5 (0.2) 4 24 (2.9) 7 2 Benzo[k]fluoranthene 0.4 (0.2) 4 4.3 (2.8) 7 9 Benzo[a]pyrene 0.8 (0.1) 4 20 (2.9) 7 4 Indeno[1,2,3-cd]pyrene ND 4 NA NA NA Benzo[ghi]perylene ND 4 NA NA NA Dibenzo[a,h]anthracene ND 4 NA NA NA Inorganics, ppm in the mainstream smoked Carbon dioxide 3057 (532) 5 >9000 3 NA Carbon monoxide 328 (76) 5 >2000 3 NA Nitric oxide 5.5 (1.5) 5 89.4 (71.6) 3 6 Other evaluations Nicotine, μg per cigarette 301 (213) 4 361 1 84 Temperature, °C 330 (10) 2 684 (197) 1 NA Number of puffs 12.6 (2.4) 32 13.3 (3.1) 6 NA Abbreviations: NA, not analyzed; ND, not detected. The techniques applied were presented earlier in Varlet et al() to analyze volatile organic compounds and nicotine. Due to there being one duplicate test, no SD can be determined. The values presented were illustrated from Vu et al() for the ISO smoking regimen and for an average of the 35 highest selling US traditional cigarette brands. Carbon dioxide was assessed with a Testo 535 (Testo), and carbon monoxide and nitric oxide were assessed with a Pac 7000 that identified carbon monoxide (Draeger). The apparatus calculated the smoke whenever generated from the syringe pump.

∗A 2017 analysis comparing IQOS to popular US sold traditional cigarettes.

References

Feb 8-9 removal of content

QuackGuru, amongst other changes, your edits removed

• from the lede, a two-word statement that the name "heat-not-burn" is controversial (edit comment: "simplified")
• this text (except context in italics), removed as off-topic:

  ["HnB"] Users experience a sudden, sharp peak in blood nicotine levels, rising just as abruptly and just as high as the peak from a regular cigarette. In this, these tobacco products differ from e-cigarettes, which show an equally high but delayed [blood nicotine] peak. A more rapid rise in blood nicotine levels is associated with greater addictiveness.... Low between-cigarette blood nicotine levels cause deteriorating mood, driving desire for the next cigarette, which relieves the mild withdrawal.

• information on the harms of nicotine use in pregnancy and breastfeeding (comment: "off-topic; source does not mention HnB products")
• this source, but not the statement it was cited for
• this source, but not the statement it was cited for.

References

From your edit summaries, the last two fell to your belief that statements should not be cited to more than one source. As you know, I disagree. Could you please not enforce this idea without consensus?

For the lede, I think the discussion above shows that there is consensus that the term "heat-not-burn" is controversial.

For the long quote and the pregnancy & breastfeeding material, you removed sources giving useful background (e.g. the comparison to e-cig nicotine delivery rates) because the sources were off-topic. If the content is on-topic, the sources that support it don't have to be. I note that after removing clarifying content cited to off-topic sources, you tagged one of the remaining sentences as needing clarification; I've re-clarified it, using an existing on-topic source.

I would like to restore specifically the content I have mentioned here. HLHJ (talk) 02:20, 10 February 2019 (UTC)

The terms heated tobacco product and heat-not-burn tobacco product are the commons names. There is no need to add unneeded additional words to the lede. The current title is controversial.

See "Users experience a sudden, sharp peak in blood nicotine levels, which rise just as abruptly, and just as high, as in the peak from a regular cigarette." That is still in the article. The source says they take short puffs.

Sources that do not mention heat-not-burn tobacco products are off-topic and therefore undue weight. There are now plenty of reviews available now that discuss pregnancy and nicotine. For example, see Draft:Electric_smoking_system#Pregnancy. Also see Talk:Marketing of electronic cigarettes/Archive 1#Article scope for a RfC. Because there are newer on-topic sources that also discuss nicotine there is no need to use off-topic sources. QuackGuru (talk) 12:36, 10 February 2019 (UTC)

It appears you read the draft and you added a source and similar content that is in the Draft:Electric_smoking_system#Pregnancy section from the draft. QuackGuru (talk) 18:37, 10 February 2019 (UTC)

Yes, that's exactly what I did, though I did not read the whole draft again (I see it's changed). You're right that of late I've spent too little time looking up new sources, and too much on talk pages. Please, if you find the sourcing for a statement poor, but know of better sources, add those sources rather than removing accurate information. HLHJ (talk) 19:12, 10 February 2019 (UTC)

Challenged content restored months later

This edit restored disputed content. See Talk:Electric_smoking_system/Archive_4#Large-scale_revert_of_health_information.

@Sennen goroshi: reverted the bold changes. See revert to prior stable version, before blatantly biased anti-ecig crusading edits were made.

The last stable version of this article was back in October 2018 before the WP:MEDRS violations were added to this article and before the image of the overcooked pizza was added. QuackGuru (talk) 16:33, 5 February 2019 (UTC)

At first glance there is unsourced content and there is content that does not adhere to a neutral point of view. For example, the last sentence is not neutral. I think it would be best to undo the edit. QuackGuru (talk) 01:38, 8 February 2019 (UTC)

As mentioned in my edit summary, a large amount of material was reverted, and some of the other material discussed, modified, and incorporated, or left out. I directly asked if anything was wrong with the portion of the reverted edits which were to the "regulations" section, but no-one gave any specific criticisms. The discussion was archived on my unanswered final request (of November) that any other problems with the reverted edits be raised. I see no unsourced content, and trust you will tag it.

The current last sentence is "After iQOS launched a marketing campaign in New Zealand, the Ministry of Health, which has the authority to regulate nicotine products, stated that the refill sticks are not legal for sale in New Zealand." The one you seem to be complaining about, and have removed, is "Later negotiation between politicians and the tobacco industry about legalization, and regulation as a consumer product rather than a medical treatment, caused controversy." (citing an article in the New Zealand Medical Journal, which said "The process through which the proposal to regulate HNB tobacco products emerged is alarming"). What is non-neutral about the article statement? How could the more recent information be presented neutrally? You also removed the first sentence of the section, "In some jurisdictions, these products are not subject to the same regulations as older tobacco products." What do you object to about this micro-lede? You said it was "unsourced", but the rest of the section sources it. HLHJ (talk) 00:59, 10 February 2019 (UTC)

It did not cause controversy. That content was clearly not neutral.

The content was unsourced. You claim other sources verify the claim but you did not provide another source to verify the claim. QuackGuru (talk) 12:40, 10 February 2019 (UTC)

I've now sourced, modified, and re-added it. HLHJ (talk) 20:12, 10 February 2019 (UTC)

The last sentence is focusing on POV language. This is "alarming". QuackGuru (talk) 00:59, 11 February 2019 (UTC)

Harm reduction quantification

The RFC bot asked me to comment on one of the RFCs here, but before I do, I would like to ask, what is the current WP:MEDRS consensus or range for harm reduction from vaping as a tobacco substitute for nicotine users? I see 95% reported in the press constantly, but when I look through Pubmed, I see figures closer to 99.5% e.g. PMID 28778971. I'd like to see pro and con arguments on this question from both sides before I weigh in, please. EllenCT (talk) 18:53, 13 February 2019 (UTC)

A heat-not-burn tobacco product (heated tobacco product) is different than an e-cig (vaping product). For content on e-cigs see "The safety of electronic cigarettes is uncertain.[1][2][3] There is little data about their safety, and considerable variation among e-cigarettes and in their liquid ingredients[4] and thus the contents of the aerosol delivered to the user.[5] Reviews on the safety of e-cigarettes have reached significantly different conclusions.[6] A 2014 World Health Organization (WHO) report cautioned about potential risks of using e-cigarettes.[7] Regulated US Food and Drug Administration (FDA) products such as nicotine inhalers may be safer than e-cigarettes,[8] but e-cigarettes are generally considered safer than tobacco.[9][10] It is estimated their safety risk is similar to that of smokeless tobacco, which has about 1% of the mortality risk of traditional cigarettes.[11] A systematic review suggests that e-cigarettes are less harmful than smoking and since they contain no tobacco and do not involve combustion, users may avoid several harmful constituents usually found in tobacco smoke,[12] such as ash, tar, and carbon monoxide.[13] However, e-cigarettes cannot be considered harmless.[14] Repeated exposure over a long time to e-cigarette vapor poses substantial potential risk.[15] Click here to read the Safety of electronic cigarettes article. Also see "A 2015 PHE report stated that e-cigarettes are estimated to be 95% less harmful than smoking,[88] but the studies used to support this estimate were viewed as having a weak methodology.[89]"[5]

There is content in the draft that explains they are different than an e-cig. See Draft:Electric_smoking_system#Construction: See "Heat-not-burn tobacco products heat tobacco leaves at a lower temperature than traditional cigarettes.[18] Heat-not-burn tobacco products usually heat up tobacco, rather than use liquids.[50] Another type of heat-not-burn tobacco product is the loose-leaf tobacco vaporizer that entails putting loose-leaf tobacco into a chamber, which is electrically heated using an element.[51] Some use product-specific customized cigarettes.[7] They are not e-cigarettes.[7] They can overlap with e-cigarettes such as combining an e-cigarette and a heat-not-burn tobacco product, for using tobacco or e-liquid.[22]"

Different sources states different things for harm reduction (reduced harm) from the use of heat-not-burn tobacco products (heated tobacco products). See Draft:Electric_smoking_system#Health_effects: See "With an assorted range of electronic cigarettes devices in the UK, it is unclear whether heat-not-burn tobacco products will offer any favorable benefit as an another plausible harm reduction product.[24]" Also see "A 2018 Public Health England (PHE) report states that the evidence indicates that heat-not-burn tobacco products may be much safer than traditional cigarettes but less safe than e-cigarettes.[24]"

See Draft:Electric_smoking_system#Emissions: "A 2018 PHE report found "Compared with cigarettes, heated tobacco products are likely to expose users and bystanders to lower levels of particulate matter and harmful and potentially harmful compounds (HPHC). The extent of the reduction found varies between studies."[32] They also noted that the evidence indicates that the levels of nicotine inhaled from heat-not-burn tobacco products is less than that of cigarette smoke.[38] Exposure to mutagenic and other harmful substances is lower than with traditional cigarettes.[20] However, reduced exposure to harmful substances does not mean that health risks are equally reduced.[20]"

See Draft:Electric_smoking_system#Marketing: "The tobacco companies use heat-not-burn tobacco products as part of their broader political and public relations activities to position them as 'partners' to address the tobacco epidemic rather than as the vectors that are causing it.[27] This is a similar strategy previously used by the tobacco industry to promote itself as a partner of public health in reducing the harms of tobacco, while obfuscating the scientific evidence pointing that harm reduction is achieved through tobacco control policies that decrease consumption.[27]"

To summarise, the WP:MEDRS consensus varies among the sources presented for both heat-not-burn tobacco products (heated tobacco products) and e-cigs (vaping products). QuackGuru (talk) 21:51, 13 February 2019 (UTC)

Thank you. What is the market share of heat-not-burn tobacco, compared to smoked tobacco products? Is vaping classified as heat-not-burn? A few of your sentences suggest yes, but some draw a distinction. Some of this difficult terminology doesn't seem suited for an encyclopedia audience. If there is a harm reduction approach in the 95-99.5% range available to hundreds of millions of patients for whom consumption decrease approaches are less successful than substitution, I'd like to understand the medical ethics involved with allowing public relations and marketing campaigns to have any bearing on indicated treatments. EllenCT (talk) 04:25, 14 February 2019 (UTC)

See Draft:Electric_smoking_system#Prevalence: The market share is generally low. Sales are expected to increase. In Japan they are popular. E-cigarettes do not involve tobacco combustion. Vaping is not classified as a heat-not-burn product. The Draft:Electric_smoking_system#Marketing section explains a little bit about the ethics. QuackGuru (talk) 17:11, 14 February 2019 (UTC)

Is there a quantity, perhaps expressed with multiple numbers such as a confidence interval, or in words, which you are comfortable with for the introductory paragraphs of this heat-not-burn tobacco product article? EllenCT (talk) 15:47, 17 February 2019 (UTC)

See the second paragraph of the draft for the MEDRS consensus in respect to safey. See Draft:Electric_smoking_system#cite_ref-FOOTNOTEWHO20166_24-0.

Also see the in introductory paragraph of Draft:Electric_smoking_system#Health_effects: "As of December 2017, it is impossible to quantify the health risk from using these products.[25] There is very limited information available on their health effects.[25]" See Draft:Electric_smoking_system#cite_ref-COT2017_26-2. No MEDRS source I read has a specific quantity regarding their safety. QuackGuru (talk) 16:47, 17 February 2019 (UTC)

Public information on nicotine's health effects, published by the US CDC (Centers for Disease Control and Prevention). From Electronic Cigarettes – What are the health effects of using e-cigarettes?.

Charred e-fluid residue in an e-cigarette mouthpiece. The e-fluid was a tobacco extract. In a conventional cigarette, liquid pyrolysis products like these are called "tar"

EllenCT, you asked for both sides. I'll do my best to give you a balanced view, and perhaps between me and QuackGuru you'll get a fair idea of the range of views.

I tried to cover the difference between these products and e-cigs in the "nature and function" section of the current article, and would really appreciate your feedback on where I was unclear and how to improve it. Fundamentally, e-cigs heat liquids, while these heated tobacco products heat solids. There are also "hybrid" products that heat both together. Many e-cigarette fluids use tobacco extracts, as these are cheaper than pharmaceutical-grade pure nicotine in at least some jurisdictions. The peak temperatures of the products vary.

What exactly this means for health risks will not be clear for a few decades, because the major harms of smoking are long-term, and take decades to develop. There is a history of "modified risk" products, products marketed by the nicotine industry in a way that gave the public the impression that they were lower-risk (so far, they've all turned out to not actually be safer, when the data finally came in). The claims of reduced harm are implied rather than directly stated by the established firms, as to make them directly would expose them to legal liability (independents are less careful, and some get fined for false advertising).

The risk claims are often founded on quantitative measurements of genuinely harmful constituents in smoke, showing that there are less of them in the new products than the old products. However, lower toxin levels don't equal lower risk. We don't really know what constituents of cigarettes are responsible for the health harms, or how they interact. Low levels of some substances may be just about as harmful as large amounts (see dose-response curve). Products can be optimized to reduce whatever is measured, on the testing rigs if not in reality (sort of like defeat devices for air pollution). And according to the Surgeon General among others, nicotine itself may be a major contributor to the health harms of cigarettes. We are quite sure that it is responsible for some things, like problems with brain development in babies whose mothers use nicotine replacement products. Nicotine alone causes an impressive list of health problems in animals (testing on non-using humans would be unlikely to pass a research ethics review committee). And of course addiction is in itself a harm.

So you have to guess what causes all the harms we know of for the old products, and then use those guesses to make a guess for the harms of the new products. Plus you have to guess the harms from the novel things in the new products (which is hard, but, for instance, many of the flavourings are known to be unsafe to inhale, as are the metals off the heating elements). Then you compare the guess for the new product to the old products, for each harm individually (ventilated cigarettes, for instance, caused an increase in some forms of lung disease, but an increase in others, relative to unventilated cigarettes). The fact that the new products are very varied and changing all the time does not help.

The idea that the health benefit is definitely a simple number, like "95%", is more than a bit odd. I'm not impressed with the people making it, including Public Health England. Nor am I impressed with PHE for taking money from manufacturers of nicotine products to fund their studies; I'm not sure if this group includes makers of e-cigarettes, or just nicotine replacement therapies, but it's still a conflict of interest. The European Public Health Association is also unimpressed; they say "The widely cited figure of 95% safer emerged from a discussion among individuals, most of whom had previously advocated for these products, who conceded the lack of evidence on which to base their conclusion."[6]

E-cigarette Use Among Youth and Young Adults, a 2016 Surgeon General's report, is a much more through literature review, but it's long and not very headline-friendly. I recommend reading the whole thing only if you are really determined. If you really, really want to know a lot more about tobacco marketing techniques, I recommend The role of the media in promoting and reducing tobacco use, a joint publication by the U.S. Department of Health and Human Services, the National Institutes of Health, and the National Cancer Institute. You'd have to be even more determined to wade through that.

Obviously the overall cost-benefit calculation has to consider many groups:

• a person who switches fully from conventional cigarettes to e-cigarettes may well have a health benefit, though we won't know for sure for decades.
• a person who uses both (dual use) can't hope to benefit much,[7] because of the big-harms-from-small-amounts effects mentioned above (this applies to many of the important risks, like major diseases, but there are some benefits to reducing consumption).
• a person who would have quit, but instead switched because it was easier, has also been harmed (internal documents show that the nicotine industry has worried a lot about this).
• a person did quit, but would have quit earlier had they not used e-cigarettes, has also been harmed.
• if a person gets addicted to nicotine through e-cigarettes, and they would never have used a conventional cigarette, then they have been harmed by e-cigarettes.
• if a person gets addicted to nicotine through e-cigarettes, and would otherwise have used a conventional cigarette, then they could have an unknown benefit.

Obviously the overall effect of e-cigarettes on population health depends on the proportions of these groups and the unknown health differences. There have been attempts to guess this, but they are just very educated guesses.[8] There are lots of unknowns (marketing, for instance, and cultural factors, and regulatory changes).

It is also an open question whether e-cigs or these solid products help smokers quit. A Cochrane review[9] on e-cigs for quitting conventional cigarettes finds remarkably few good-quality studies on the question. There is evidence from other fields that researchers with conflicts of interest influence the research literature by asking the right questions. If it were easy to produce a really solid study showing that a new product helped smokers quit, then some of the people selling them have plenty of funding for such a study. Currently, the US Food and Drug Administration fines anyone who claims that e-cigs help you quit for false advertising. In the UK, no e-cigarette has been approved as a smoking cessation product, but they are widely promoted as quitting devices (though the UK National Institute for Health and Care Excellence has advised doctors not to).

Actually, horribly, there is controversy over the evidence that nicotine replacement therapy helps people quit. In controlled, randomized trials, it seemed to have an effect, but in field studies it's hard to see. Hopefully we'll have better evidence soon.

Population surveys show a lot of dual use. There is some evidence that population-level quitting rates have risen, but also that more people are getting hooked on nicotine because of e-cigarettes, with the percentage using conventional cigarettes falling or stable while the percentage using all nicotine products is rising.[10] Traditionally, with cigarettes, youth (almost no-one starts smoking after their mid-twenties) have gotten hooked on easy-to-use flavoured cigarettes with minimal throat hit (throat hit is an initially unpleasant spasm of the throat, which smokers learn to associate with nicotine-coming-soon, and thus learn to like; it then reinforces addiction, as a bridging stimulus). Established smokers prefer a stronger throat hit and care less about flavours. After you've looked at historic tobacco industry documents on these product categories, it's not hard to look at e-cigs and see some that look aimed at established smokers and some that look aimed at new users.

For background, regular smokers experience normal moods only at peak blood nicotine levels. The rest of the time, their moods are slightly worse. If they increase their peak nicotine level, say by puffing a bit harder, or smoking more cigarettes, they initially feel a bit better, but their body soon adjusts.[11] It's the abrupt lift in mood when dependent people smoke that makes the cigarettes addictive. Over the years, cigarettes have been modified to make them more addictive. A plain tobacco cigarette will go out if you put it down; a commercial one has been modified so the it will carry on burning, which encourages the smoker to smoke it all at once. Assorted chemicals modify the throat hit.

E-cigarettes started out being made by independents who honestly wanted to help people quit. You can tell. You can fill an e-cig with any e-fluid. You can make your own e-fluid, if it's legal in your jurisdiction. You can adjust and modify your e-cigarette. And the blood nicotine rise in the older models was fairly slow; a slow nicotine rise generally makes nicotine products less addictive. You can take as few puffs as you like and put them in your pocket, meaning your nicotine levels are much more stable than when smoking conventional cigarettes. This also seems like it ought to make them less addictive, and easier to quit, than regular cigarettes.

E-cigs are now increasingly being made by the big old nicotine companies which have historically worked hard and successfully on stopping people from quitting. Let's look at JUUL e-cigs (actually a new company, but now pretty big). They sell proprietary cartridge refills, and go after anyone who sells compatible refills with a vengeance and a solid legal team (why we allows patents on addictive devices I do not know). They have a bridging stimulus, which makes them more addictive; it's reportedly a benzoic-acid-triggered throat sensation, apparently less offputting to novices. They have flavours. The devices look like USB sticks and have no settings; they are easy to use. They have marketing which has been described as targeting youth, some of which they have modified under this criticism. They seem to be more addictive than the older products, although again you can't really do an experiment.

Now let's look at IQOS. It uses proprietary refills, and an interlock to forced you to smoke the whole thing at once. The refill cigarettes use less tobacco, but delivers similar amounts of nicotine to a regular cigarette, meaning they are probably cheaper to make. Blood nicotine levels rise just as fast as after a regular cigarette, but then they fall faster, which presumably means that the urge for another cigarette sets in sooner. People switching to IQOS come to smoke more IQOS cigarettes than they did conventional cigarettes. This looks like a product designed to addict and make a profit. It does not look like a product designed to help quitting.

I'm all in favour of harm reduction. I am not in favour of fake harm reduction; you need evidence before you can say that something reduces harm. Past false harm reduction in this field has caused a lot of needless suffering and death. As you may have gathered, I am deeply cynical about the motives of large nicotine companies, many of which have a legal obligation to their shareholders to maximize profit. I am also deeply cynical of the marketing techniques used by the industry, including techniques involving the media, search engine optimization, public health bodies, regulatory agencies, and the academic literature (it's useful to not only check the PubMEd COI statements, but look up the authors and funders on TobaccoTactics). This article we are discussing was originally largely written by Phillip Morris, who sell the most common product of this type. My cynicism may be partly because I came at this topic from a conflict-of-interest perspective. I wrote much of Conflicts of interest in academic publishing, History of nicotine marketing, Nicotine marketing, and E-cigarette marketing (currently in poor shape). My POV . I hope this was helpful. Please feel free to ask for clarification or just plain criticize. HLHJ (talk) 06:08, 18 February 2019 (UTC)

Claiming that it is "Charred e-fluid residue in an e-cigarette mouthpiece." is original research. QuackGuru (talk) 21:13, 21 February 2019 (UTC)